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目的探讨全腔静脉-肺动脉连接术(TCPC)治疗复杂先天性心脏病的围术期管理。方法回顾分析解放军91中心医院2002年1月至2011年5月施行TCPC术53例患者的临床资料,其中一期手术31例,二期手术22例。术前做好术前状况评估;术后入住重症监护室(ICU)期间做好循环、呼吸功能监测,观察体静脉与肺动脉连接通路通畅程度,控制合适的补液量,促进静脉回流,降低肺血管阻力和压力;加强胸引管管理,监测早期胸腔引流量。结果术后早期(术后1个月)死亡4例(7.5%),死亡原因:多脏器功能衰竭、心脏骤停、感染、蛋白丢失性肠病和低心排血量。其余患者出院前复查心脏彩超显示吻合口通畅,心功能评级为纽约心脏协会功能II级,恢复良好。结论对于适应证明确的复杂先天性心脏病患者行TCPC手术治疗,围术期加强术前评估、术中体外循环管理、术后循环功能、呼吸功能监测,能够有效提高手术成功率及促进患者术后早期恢复。
Objective To investigate perioperative management of complex congenital heart disease by total cavopulmonary connection (TCPC). Methods The clinical data of 53 patients undergoing TCPC from January 2002 to May 2011 in People’s Liberation Army 91 Central Hospital were retrospectively analyzed. Among them, 31 cases were performed in the first phase and 22 cases were performed in the second phase. Preoperative assessment of preoperative conditions; Postoperative intensive care unit (ICU) during the cycle, respiratory function monitoring, observation of body and pulmonary pulmonary artery access patency, control the appropriate volume of fluid to promote venous return, lower pulmonary vascular Resistance and stress; strengthening management of thoracic tubes and monitoring of early thoracic drainage. Results In the early postoperative period (1 month after operation), 4 patients died (7.5%). The causes of death were multiple organ failure, cardiac arrest, infection, protein-losing enteropathy and low cardiac output. The rest of the patients were reviewed before leaving the hospital for examination by color Doppler ultrasound showed anastomotic patency, cardiac function rating for New York Heart Association II function, recovery was good. Conclusions TCPC surgery is an effective way to diagnose patients complicated with congenital heart disease complicated with congenital heart disease. Perioperatively, preoperative evaluation, extracorporeal circulation management, postoperative circulatory function and respiratory function monitoring can effectively improve the success rate of operation and promote the operation of patients After the early recovery.